Pain Medicine Fellowship Curriculum

At Wake Forest School of Medicine, during the procedure/consult rotation, the fellows provide interventional and surgical pain medicine procedures, and also oversee the inpatient consult service. Ninety-­‐five percent of the procedures are performed under fluoroscopy or ultrasound guidance. A full variety of interventions are performed including:

  • Stellate ganglion blocks
  • Celiac plexus blocks
  • Lumbar sympathetic blocks
  • Superior hypogastric blocks
  • Ganglion of impar blocks
  • Cervical, thoracic, lumbar and caudal epidural steroid injections
  • Cervical thoracic and lumbar transforaminal epidural steroid injections
  • Cervical, thoracic and lumbar facet blocks
  • Gasserian ganglion blocks
  • Sphenopalatine ganglion blocks
  • Greater and lesser occipital nerve blocks
  • 3rd occipital nerve blocks
  • Cervical, thoracic and lumbar discograms
  • Percutaneous decompression
  • Radiofrequency denervation of gasserian ganglion
  • Cervical facet and lumbar facet radiofrequency denervation
  • Spinal cord and DRG stimulator trials
  • Intra-articular injections of all major joints
  • All peripheral nerve injections as indicated
  • Cryoablation of peripheral nerves and dorsal root ganglion

Surgical implants are performed at all facilities. The surgical block time averages 10-­16 surgical procedures per month. Of note, neuromodulation and intrathecal drug delivery procedures comprise the majority of these cases, though there is also exposure to vertebroplasty and kyphoplasty techniques. Occipital nerve stimulators, as well as a variety of other peripheral nerve stimulators are implanted in addition to the over 200 permanent spinal cord stimulator implants performed per year. The case volume at Wake Forest Baptist Pain Medicine and Carolinas Pain Institute provides an outstanding interventional training experience for the fellows.

Fellows manage patients that suffer from a wide variety of painful conditions and pain syndromes including:

  • Neuropathic
  • Orthopedic
  • Rheumatologic
  • Traumatic
  • Myofascial
  • Sympathetic
  • Degenerative
  • Oncologic

The attending physician provides fellow supervision, ensuring appropriate patient care and ongoing case-based learning.

Clinical Rotations

Pain Medicine fellows rotate through clinics at Wake Forest Baptist Health and Carolinas Pain Institute (CPI) with primary responsibility for new patient evaluations and existing patient management.

Fellows also rotate through procedures at:

  • Wake Forest Pain Centers
    • WFBH Pain Services – Brookstown
    • WFBH Pain Management – Lexington
    • Medical Plaza – Miller 
    • WFBH Spine Center – Clemmons
    • Ambulatory Surgery Center (ASC) – Clemmons
    • Premier Pain Clinic – High Point
    • Premier Ambulatory Surgery Center (ASC) – High Point
  • Novant Medical Park Hospital Fluoroscopy Suite (at CPI)

Outpatient procedures are performed daily by the fellows at these state-of-the-art facilities. Each fellow dedicates an average of one day per week to performing all of the blocks. Procedures are performed under either fluoroscopic or ultrasound guidance.

Fellows will also:

  • Oversee the inpatient consultation service at Wake Forest Baptist Health and Novant Health.
  • Perform operating room-based procedures
  • Perform office-based spinal cord stimulator trials

The majority of invasive procedures are performed at either Wake Forest Baptist Health or Novant-Medical Park Hospital. Chronic pain consultations are provided for inpatients at Wake Forest Baptist Medical Center. The fellows cover this rotation for one week at a time.

Fellows play an instrumental role in educating and overseeing junior and senior Anesthesiology residents in their pain medicine education when they rotate through the Wake Forest Pain Centers.

Multidisciplinary learning is further enhanced with rotations with:

  • Neurology
  • Physical Medicine & Rehabilitation
  • Radiology
  • Psychiatry

On Call Duties

Pain management fellows are actively involved in organization of the clinics at Wake Forest and CPI. They also manage patient callbacks and help to coordinate the surgical schedule.

Conferences and Didactics

Fellows participate in weekly didactic seminars from the teaching staff covering Accreditation Council for Graduate Medical Education (ACGME) pain topics as well as regular journal clubs and morbidity and mortality (M&M) conferences. The trainees also present on a topic of their choosing.

Research Opportunities

The Pain Mechanisms Laboratory at Wake Forest Baptist Health offers cutting-edge basic and translational science pain research opportunities, led by Dr. James Eisenach. Trainees may use this laboratory space as needed during their training and are invited to participate in non-basic science translational research.

Clinical translational research and biomedical informatics is led by Dr. Robert Hurley and staffed by Wake Forest Pain and Anesthesiology faculty. Clinical research trials are performed at Wake Forest and CPI. Fellows are allowed to participate.

Patients are also considered for ongoing research studies, as appropriate.